Clinical short-term outcome of severe untreated aortic stenosis

Background: sclerocalcific aortic valve is a common condition. Risk stratification and decision making is particularly complex in adults with aortic stenosis [AS], because the disease mainly affects elderly patients who represent a heterogeneous population and require balanced and individualized analysis using a multidisciplinary collaboration. Further research is needed to provide better evidence in particular on spontaneous risk, earlier detection of LV dysfunction, and the results of transcatheter treatment and medical therapy

Objectives: to study the clinical short term outcome of the severe untreated severe sclerocalcific aortic valve stenosis and also to evaluate the correlation between echocardiography assessment of aortic stenosis and clinical history and examination

Methods: in our study of 50 patients with severe sclerocalcific aortic stenosis, were subjected to full history taking along with full clinical examination and transthoracic echocardiography at baseline and follow up. The TTE criteria for diagnosis of severe Sclerocalcific aortic stenosis are increased echogenicity and thickening of the aortic valve leaflets with mean gradient greater than 40 mm Hg, and maximum jet velocity greater than 4 m per second, valve area less than 1.0 cm[2]

Results: at short term follow up of our patients [2 years], there were significant increase in the number of patients who developed symptoms of angina and heart failure [p<0.01] but there was no statistically significant increase in those who develop syncope [P=0.106]. There were very evident echocardiographic findings in the form of highly significant [p<0.01] decrease in the EF and valve area and increase in the MPG, PPG, Max. Jet velocity

Conclusion: 41.2% of previously asymptomatic patient developed symptoms at follow up. There were very evident and significant changes in the echocardiographic findings related to significant decrease in the EF and vave area and increase in the MPG, PPG, Max.jet velocity and intracardiac dimensions that is reflected in the clinical symptoms progression throughout the follow up period

Value of pre-procedural multi-detector computed tomography angiography prediction outcome in retrograde approach recanalization for coronary chronic total occlusion

Background: computed tomography coronary angiography[CTCA] can be useful in procedure planning for CTO PCI by identifying factors known to influence PCI success rates, such as calcification, severe tortuosity and length of the occluded segment. Percutaneous coronary intervention for CTO is considered to be one of the most challenging procedures of interventional cardiology, and in the earlier studies, successful recanalization rates of CTO ranged from 51% to 74%. However, with improved operator experience and the development of novel equipment and techniques, procedural success rates have been increased, which brings an increasing number of CTO into a treatable category

Patients and Methods: an exploratory pilot study was conducted on 40 patients using retrograde wire approach with various strategies by highly experienced CTO operators in Ain Shams University hospitals and in Kobry Elkobba Military hospital from August 2015 to 2017

Results: according to the results CTOs were divided into two groups, group1 with successful retrograde PCI in 32 pts. [80%], and group 2 with failed-retrograde PCI in 8 pts. [20%] All CTOs were correctly identified by MIP, MPR, cMPR images. Most of the CTOs were located in the proximal 21 patients 52.5% then mid 14 patients 35% ostial 3 patients 7.5% and lastly distal 2 patients 5%. In failed group there were more calcified plaques. There was more calcification in the CTOs segments [p=0.005]. Ten arc-calcified and two circular-calcified lesions were identified only 4 from ten patients [40%] had arc calcified Plaques which were successfully recanalized and 6 patients 60% failed. In circular-calcified lesions one patient [50%] succeeded and one failed. Proximal artery tortuosity between two groups showed a significant difference [p=0.000]

Conclusion: complex CTO lesion morphology is still an important issue for CTO-PCI procedural success, and further improvement of technologies [MDCT] and medical devices, such as guide wires and catheters are required to improve the success rate

Intracoronary adenosine as an adjunct to primary coronary intervention in acute myocardial infarction

Primary percutaneous coronary intervention [PCI] has resulted in marked reduction in the incidence of reinfarction death and stroke in the setting of acute myocardial infarction. However, its beneficial effects are limited by reperfusion injury. Adenosine limits reperfusion injury in animal models. The aim of this study was to evaluate the feasibility safety and value of intracoronary adenosine as an adjunct to primary PCI in acute myocardial infarction. The study included 60 patients with acute ST-elevation myocardial infarction within 6 hours of the onset of chest pain referred for primary PCI. Patients were divided into two groups, the adenosine group, included 20 patients who received intracoronary adenosine as an adjunct to primary PCI; and the control group, included 40 patients, who received saline instead. All patients had 12-lead ECG before and after intervention cardiac enzynes estimation and detailed assessment of angiographic data during PCI emphasizing on post-intervention TIMI flow and TIMI myocardial perfusion grading [TMP]. Conventional and pulsed tissue Doppler examinations were done within 24 hours after PCI and one week later to evaluate wall motion and myocardial velocities within the reperfused segments. Both groups were matched in teens of age sex risk factors, infarct location and distribution of coronary artery disease. Though the mean time from onset of chest pain to PCI was significantly shorter in the control group, the adenosine group demonstrated significantly lower enzymatic peaks [1880.3 +/- 1020.4 versus 2806 +/- 1379.8; P < 0.01], significantly higher incidence of TIMI III flow [95% versus 65%; P < 0.03]. significantly higher incidence of TMP III grace [85% versus 40%; P < 0.007], significantly lower TIMI frame count [11.5 +/- 3.1 versus 23.1 +/- 9.8 frames: P < 0.0001] and markedly lower incidence of no-reflow compared to the control group [10% versus 45% P < 0.006] at day 7, only adenosine group demonstrated significant improvement in ejection fraction, systolic wall motion score indices with striking improvement in the annular and segmental S wave velocities recorded by tissue Doppler. Adenosine administration in the setting of primary PCI for ecute myocardial infarction is safe, significantly limits reperfusion injury and improves myocardial perfusion thus optimizing the results of PCI

Study of the immune response of hepatitis B vaccination in Egyptian pre-school children

Abstract: Although immunization of infants against hepatitis B virus [HBV] is the most effective way to prevent infection, duration of the afforded protection is controversial. Titers of ani-HBV antibodies tend to decline with age. The Aim of this study is to evaluate the immune response to hepatitis B vaccination in a sample of vaccinated Egyptian pre-school children and the impact of serum ferritin on this response

Subjects and Methods: Serum samples were collected from 91 apparently normal children 5-6 years old, who were fully vaccinated in infancy according to Egyptian immunization schedule, during the period from January to June 2005. HBs antibody titer was assayed by ELIZA, colorimetric determination of serum albumin and serum ferritin estimation by enzyme immunoassay were performed. Body mass index [BMI] was calculated in all children

Results: A total of 49 [53.8%] tested positive response for HBs antibody including [43 weak responders [10-100m IU/L] and 6 high responders [>100mIU/L]] and 42 [46.2%] showed inadequate response [< 1mIU/L]. The mean value of serum ferritin [86.9 ug/L] in responders was significantly higher [P = 0.001] when compared to inadequate responders [62.8ug/L]. No statistically significant difference regarding sex, locality [rural or urban], serum albumin and BMI were detected in between

Conclusion: High ferritin level [within normal range] may contribute to good immune response to hepatitis B vaccine. Booster dose of HB vaccine should be highly considered to enhance immune protection of the vaccine

Antioxidant value of bilirubin in sick and healthy neonates

To identify the beneficial role of bilirubin as an antioxidant, this study was carried out on 44 sick neonates suffering form respiratory distress syndrome, sepsis, meconium aspiration and birth asphyxia; in addition to 11 healthy ones as controls. The results showed that the mean values of total bilirubin levels in controls [4.4 +/- 0.3], [9.1 +/- 0.5] and [12.8 +/- 10.7 mg/dl] in 1st, 2nd and 3rd days of life respectively, were significantly higher than [3.9 +/- 1.1], [6.3 +/- 1.5] and [8.2 +/- 2.1 mg/dl] values observed in sick group in 1st, 2nd, and 3rd days of life respectively, The rate of serum bilirubin rise was 4.2 mg/dl/day in control group which was significantly higher than [2-2 mg/dl /day] in sick group- The serum lipid peroxide in controls [14.5 - +/- 1.3 nmul/ml] was significantly lower than [19.3 + /-1,05] n mol/ml in sick group. The serum lipid peroxide correlated negatively with the rate of bilirubin rise. We can conclude that jaundice is not simply an accumulation of a potentially toxic waste product but may serve a beneficial role in providing high concentration of a free radical absorbing antioxidant

Prevalence of cytomegalovirus infection in acute lymphoblastic leukemia

Sixty children with acute lymphoblastic leukemia [ALL] were divided into 3 groups: 20 children at diagnosis of ALL compared to 20 children under maintenance therapy and 20 children in hematological relapse. The ALL patients were compared to 22 healthy control children of similar age and sex. All the control cases proved to be CMV-IgM negative. The prevalence of seropositive CMV IgM antibody was 40 percent in the relapse with a level of 20.9 +/- 17.71 EU/ml and the group under maintenance therapy 21.6 +/- 18.5 EU/ml. The 3 groups were statistically significant when compared to the control group 6.7 +/- 3.7 EU/ml. 22 ALL patients CMV IgM [+ ve] were detected, 15 patients in early acute infection and 7 patients in late acute infection. 15 patients with CMV IgM above 30 EU/ml and CMV IgG 15-80 EU/ml [early acute infection]: 7 cases in the relapse group by comparison to 4 patients in the group under maintenance therapy and 4 patients at diagnosis. 7 patients in late acute infection with CMV IgM 20-30 EU/ml and CMV. IgM 15-80 EU/ml: 4 patients in the maintenance group, 2 patients of diagnosis, 1 patient in relapse. In the relapse group 83.33 percent of seropositive CMV-IgM patients received blood transfusion. We suggest that CMV negative blood products should be used exclusively to support all acute lymphoblastic leukemia [ALL] especially those receiving chemotherapy in whom bone marrow transplant is a therapeutic option

Case control hospital study of risk factors in persistent diarrhea

For detection of the possible risk factors causing persistent diarrhea, 240 diarrhea cases aged below 5 years; 70 with acute diarrhea were studied. The results showed that malnutrition, bad housing, low economic level, increased number of house holding and decreased mean duration of breast feeding significantly predominated in persistent cases, while age, sex, mother's education, residence, feeding pattern and mean age of starting non-breast milk or semisolid showed no significant difference regarding early administration of ORS, while the majority of persistent cases received antibiotis and/or antiprotozoal medication before coming. Microscopic examination of stools showed significant difference about parasitic infection. Carbohydrate malabsorption as detected by stool acidity and stool reducing substances predominated significantly in persistent cases. Salmonella, Staph, aureus and K. pneumoniae organisms were detected by stool cultures only in persistent cases, E. coli was observed in both types of diarrhea, but needed further serotyping

Evaluation of the problem of poliomyelitis before and after mass vaccination programme

On an attempt to evaluate the effectiveness of poliomyelitis mass vaccination program introduced in 1967, [7706] children classified into three different groups were included in this study. The cases were studied for age, sex, status of previous vaccination, history of the disease and clinical examination. The first group included [2778] children aged from [6-12] years and not subjected to mass campaigns, 8 case with residual paralysis from poliomyelitis were detected in this group. The second group included [2930] children from [0.6] years and subjected to mass vaccination campaign. Only a single case was detected. A third comparative group included [1998] children aged from [13-16] years in the period from 1966-1968 before the conduction of the compulsory vaccination was studied. 10 cases with residual paralysis were detected. Incidence rate of poliomyelitis before conduction of compulsory vaccination was 5/1000, reduced after its conduction in 1968 to be 2.87/1000. Finally it is markedly reduced after conduction of mass vaccination campaigns into 0.34/1000. this rejects the effectiveness of vaccination in controlling the disease, and success of mass vaccination program in reducing the number of poliomyelitis cases more than the compulsory vaccination has achieved